Spine Journal最新文献

{"title":"Large language models versus NASS common coding scenarios: an analysis of accuracy and financial implications using 2026 CPT AMA Codebook Guidelines.","authors":"Christopher J Fang, Jeffrey Lucas Hii, Matthew Michelberger, Joaquin Del Mundo, Ian Alexander, Sukanta Maitra","doi":"10.1016/j.spinee.2026.08.011","DOIUrl":"10.1016/j.spinee.2026.08.011","url":null,"abstract":"<p><strong>Background context: </strong>Accurate current procedural terminology (CPT) coding is essential for compliant revenue cycle management in spine surgery. However, increasing documentation burdens and the complexity of bundling rules often lead to significant revenue leakage or audit risk.</p><p><strong>Purpose: </strong>To evaluate the baseline efficacy of three state-of-the-art large language models (LLMs) in generating accurate CPT codes compared to the \"Gold Standard\" North American Spine Society (NASS) Common Coding Scenarios and to quantify the downstream financial impact.</p><p><strong>Study design/setting: </strong>Comparative artificial intelligence performance analysis.</p><p><strong>Patient sample: </strong>Twenty standardized clinical vignettes selected from the NASS Common Coding Scenarios guide, representing a broad spectrum of spine pathology, including cervical decompression/fusion, lumbar decompression, lumbar fusion, and complex deformity.</p><p><strong>Outcome measures: </strong>Exact match accuracy, error of omission (undercoding), error of commission (overcoding/unbundling), and net financial variance utilizing 2026 Medicare Physician Fee Schedule wRVU values mapped to a standardized commercial conversion factor of $60/Work RVU.</p><p><strong>Methods: </strong>Each vignette was input into three LLMs: GPT-4o (OpenAI), Gemini 1.5 Pro (Google), and Claude 4.6 Sonnet (Anthropic). Under isolated zero-shot conditions, the models were prompted to function as certified professional coders and generate the appropriate CPT codes and modifiers. Outputs were scored against the official NASS answer key, and subsequent financial variances were calculated.</p><p><strong>Results: </strong>Gemini 1.5 Pro achieved an exact match rate of 65%, followed by ChatGPT-4o (55%) and Claude 4.6 Sonnet (40%), though these differences in overall performance were not statistically significant (p=.28). However, performance varied substantially by procedure type; notably, both ChatGPT and Claude achieved a 0% exact match rate for lumbar fusion constructs, frequently failing to correctly bundle interbody and posterior instrumentation codes. Financially, Gemini 1.5 Pro was the most stable, resulting in a negligible mean net revenue variance of -$2.16 per case. In contrast, ChatGPT and Claude demonstrated a strong tendency toward overcoding and high financial volatility, resulting in mean net revenue overcharges of +$75.60 and +$104.07 per case, respectively.</p><p><strong>Conclusions: </strong>While no statistically significant difference in overall accuracy was detected between models, qualitative deficits remain severe in handling complex fusion hierarchies. This study evaluates baseline performance under isolated zero-shot conditions; the tendency of Claude and ChatGPT to create unbundled billable codes presents a severe audit risk, while Gemini demonstrated a lower mean financial variance. Currently, LLMs should function only as adjunctive tools re","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing differently: the philosophical impact of new technology on spine surgery.","authors":"Faith C Robertson, Eric Shaker, Muhammad Abd-El-Barr","doi":"10.1016/j.spinee.2026.08.001","DOIUrl":"10.1016/j.spinee.2026.08.001","url":null,"abstract":"","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of biportal endoscopic spine surgery compared with microscopic surgery for lumbar degenerative diseases: a pooled analysis of 2 randomized controlled trials.","authors":"Sang-Min Park, Kwang-Sup Song, Ho-Joong Kim, Min-Seok Kang, Ki-Han You, Jin-Sung Kim, Hyun-Jin Park","doi":"10.1016/j.spinee.2026.07.011","DOIUrl":"10.1016/j.spinee.2026.07.011","url":null,"abstract":"<p><strong>Background context: </strong>Although biportal endoscopic spine surgery (BESS) has shown clinical benefits for lumbar degenerative diseases, comprehensive cost-utility analyses comparing BESS with microscopic spine surgery (MSS) remain limited.</p><p><strong>Purpose: </strong>We aimed to compare the cost-effectiveness of BESS and MSS for lumbar degenerative diseases from a healthcare provider's perspective using quality-adjusted life years (QALYs) as the effectiveness measure.</p><p><strong>Study design: </strong>This economic evaluation was conducted alongside 2 multicenter, prospective, blinded, randomized controlled trials (ENDO-BH for lumbar disc herniation and ENDO-BS for lumbar spinal stenosis) at 6 tertiary hospitals in South Korea.</p><p><strong>Patient sample: </strong>Overall, 220 patients aged 20 to 80 years requiring single-level lumbar surgery were randomized to the BESS or MSS groups, and 187 patients with complete 12-month follow-up data were included in the analysis (BESS, 96; MSS, 91).</p><p><strong>Outcome measures: </strong>The primary outcome was the incremental cost-effectiveness ratio expressed as cost per QALY gained. Secondary outcomes included net monetary benefit (NMB) and probability of cost-effectiveness at the Korean willingness-to-pay (WTP) threshold. QALYs were calculated using the area under the curve of EQ-5D-5L utility values measured at baseline, 2 weeks, 3 months, 6 months, and 12 months postoperatively.</p><p><strong>Methods: </strong>Costs were measured from the healthcare provider's perspective using institutional billing data adjusted to Korean won (KRW). Non-parametric bootstrapping (5,000 iterations) was performed to estimate uncertainty, and cost-effectiveness acceptability curves were constructed.</p><p><strong>Results: </strong>The mean 1-year QALYs were 0.823±0.079 for BESS and 0.801±0.112 for MSS. The total costs were USD 3,028 for BESS and USD 3,080 for MSS. Confidence intervals for incremental costs and QALYs crossed zero. At the WTP threshold of USD 21,429 (30,000,000 KRW) per QALY, the probability that BESS would be cost-effective was 94.9%.</p><p><strong>Conclusions: </strong>BESS is a cost-effective alternative to MSS for treating lumbar degenerative diseases, with a cost-effectiveness probability of 94.9% at the WTP threshold during the 12-month follow-up. Neither technique showed a statistically significant advantage in terms of cost or QALYs, indicating that BESS can be adopted without increasing direct medical costs.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reassessing bladder recovery in cauda equina syndrome: long-term outcomes after surgical decompression:a systematic review and meta-analysis.","authors":"Elie Najjar, Rodrigo Muscogliati, Charlie Trumble, Weronika Nocun, Negin Nematiniaye Masooleh, Emily Lindridge, Aaron Chitty, Daniel D'aquino, Michael Grevitt, Nasir Quraishi","doi":"10.1016/j.spinee.2026.07.005","DOIUrl":"10.1016/j.spinee.2026.07.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Bladder dysfunction is the most clinically significant manifestation of cauda equina syndrome (CES) and a key determinant of long-term disability. However, reported recovery rates after surgical decompression vary widely, and the true prevalence of persistent bladder dysfunction remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate long-term bladder outcomes following surgical decompression for degenerative spine related cauda equina syndrome and to quantify the prevalence of persistent bladder dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review and meta-analysis of observational studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients with cauda equina syndrome secondary to degenerative lumbar spine disease undergoing surgical decompression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Persistent bladder dysfunction at ≥12 months follow-up, including urinary retention, incontinence, voiding dysfunction, need for catheterization, abnormal urodynamics, or validated urinary symptom scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review was conducted according to PRISMA guidelines. MEDLINE, Embase, and PubMed were searched from inception to 16 December 2025 for studies reporting long-term bladder outcomes following surgical decompression for CES secondary to degenerative spine disease. Observational studies with ≥12 months follow-up were included. Data on study characteristics, CES subtype, timing of surgery, and bladder outcomes were extracted. Random-effects meta-analysis was used to estimate the pooled prevalence of persistent bladder dysfunction. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixteen studies comprising 987 patients were included. Persistent bladder dysfunction at final follow-up was reported in 285 patients, corresponding to a pooled prevalence of 32.6% (95% CI: 23.4%-41.9%; I²=89.8%). Among patients presenting with preoperative bladder dysfunction, crude paired data demonstrated persistent dysfunction in 130/278 patients (46.8%). In subgroup meta-analysis of studies reporting outcomes specifically in this population (8 studies; n=422), the pooled prevalence of persistent dysfunction was 29.7% (95% CI: 20.4-39.1). Studies consistently reported worse outcomes in patients presenting with urinary retention compared with incomplete CES. Evidence regarding the effect of surgical timing on long-term bladder outcomes was heterogeneous and inconclusive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Approximately one-third of patients undergoing decompression for CES secondary to degenerative lumbar pathology have persistent bladder dysfunction at long-term follow-up. Preoperative clinical severity, particularly the presence of urinary retention, appears to be an important clinical factor associated with recovery, although evidence from adjusted analyses remains limited. Standardized outcome definitions and pro","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining clinically meaningful functional recovery following lumbar spine surgery: minimal clinically important differences for objective gait and balance biomarkers.","authors":"Ram Haddas, Ye Shu, Gabriel Ramirez, Varun Puvanesarajah, Paul Rubery","doi":"10.1016/j.spinee.2026.07.017","DOIUrl":"10.1016/j.spinee.2026.07.017","url":null,"abstract":"<p><strong>Background context: </strong>Objective gait and balance assessments provide quantitative insights into functional impairment in lumbar degenerative spine disease. However, the absence of minimal clinically important difference (MCID) thresholds limits their clinical interpretability and integration into spine care.</p><p><strong>Purpose: </strong>To define MCIDs for objective gait and balance biomarkers in patients undergoing surgical treatment for lumbar degenerative spine disease.</p><p><strong>Study design/setting: </strong>Prospective longitudinal cohort study.</p><p><strong>Patient sample: </strong>One hundred eleven patients undergoing surgical intervention for lumbar degenerative spine disease.</p><p><strong>Outcome measures: </strong>Spatiotemporal gait parameters (eg, walking speed, cadence, stride characteristics), Gait Deviation Index, and balance metrics including head, center of mass, and center of pressure sway.</p><p><strong>Methods: </strong>Patients were evaluated preoperatively and at 3, 6, and 12 months postoperatively using three-dimensional motion analysis. MCIDs were calculated using five complementary approaches: distribution-based (1/2 baseline standard deviation, 1/2 change-score standard deviation), measurement error-based (minimum detectable change at 90% and 95% confidence levels), and anchor-based methods. Final MCID thresholds were derived by averaging distribution-based, change-based, and anchor-based estimates.</p><p><strong>Results: </strong>Final averaged MCID thresholds demonstrated clinically meaningful change for key gait parameters, including walking speed (0.14 m/s), cadence (7.8 steps/min), stride time (0.11 s), and step length (0.05 m). Balance-related MCIDs included head sway (0.95-0.98 cm), center of mass sway (0.51-0.54 cm), and center of pressure sway (0.57-0.70 cm in planar measures and 28.71 cm for total excursion). MCID estimates were consistent across methods for gait variables, whereas greater variability was observed in balance metrics.</p><p><strong>Conclusions: </strong>This study defines clinically interpretable MCID thresholds for objective gait and balance biomarkers in lumbar degenerative spine disease. These thresholds support the integration of motion analysis into clinical practice and enable more precise interpretation of postoperative functional recovery.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International value-based programs.","authors":"Kevin J McGuire, Jiaoyuan Elisabeth Sun","doi":"10.1016/j.spinee.2026.07.013","DOIUrl":"10.1016/j.spinee.2026.07.013","url":null,"abstract":"<p><p>Value-based (VB) models of care similar to CMS's TEAM have been developed and implemented in several countries. The purpose of this review was to examine the current state of international (VB) care models in terms of purpose, scale, scope, parameters, mechanics and where possible, limitations and successes in the context of TEAM. Methods: Targeted, mixed source review to identify international VB models relevant to spine surgery. Most, however, are in the early adoption stages and differ widely in scale and structure. However, by comparing TEAM to a Spine specific VB model in Stockholm, there are significant differences in philosophy that are built into the model design.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative metabolite ratio improves prediction of postoperative recovery in degenerative cervical myelopathy: a prospective cohort study.","authors":"Karthik Ramachandran, Ajoy Prasad Shetty, Pushpa Bhari Thippeswamy, Harikrishna Raghuraj Ramasamy, Swathikaa Ponnuraj, Rishi Mugesh Kanna, Shanmuganathan Rajasekaran","doi":"10.1016/j.spinee.2026.07.009","DOIUrl":"10.1016/j.spinee.2026.07.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction worldwide. Despite surgical decompression being the standard of care, postoperative recovery remains highly variable. Conventional MRI provides anatomical information yet correlates poorly with functional outcomes. Magnetic resonance spectroscopy (MRS) provides metabolic insights into neuronal integrity, gliosis, and energy metabolism; however, its prognostic utility in DCM remains incompletely validated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the predictive value of preoperative MRS-derived metabolite ratios, alongside clinical and imaging parameters, and to develop and validate a simplified Predictive Recovery Score (PRS) for prognostication. A comparative model analysis was performed to determine the incremental contribution of MRS beyond clinical and structural parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Prospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Sixty-nine consecutive patients with cervical myelopathy undergoing surgical decompression were enrolled and followed for 2 years. No patients were lost to follow-up after enrolment; all 69 patients completed the 24-month assessment and were included in the final analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Neurological recovery was assessed using the modified Japanese Orthopaedic Association (mJOA) score and Hirabayashi's recovery rate formula. Patients were stratified into good-recovery (&gt;50%) and poor-recovery (&lt;50%) groups. A secondary analysis using a minimum clinically important difference (MCID ≥2 mJOA points) was also performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Demographic, clinical, and imaging data were collected, including comorbidities, stenosis grade, compression ratio, and diffusion tensor imaging (DTI) metrics. Single-voxel MRS at the C2 level quantified various metabolites and metabolite ratios. Group comparisons, correlation analyses, and ROC curves were performed to assess the correlation between the metabolites and recovery rate. Logistic regression identified predictors of recovery. Incremental model performance was assessed by comparing 3 nested models. Internal validation was performed using bootstrap resampling and leave-one-out cross-validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-five patients achieved good recovery, while 34 had poor recovery. Comorbidities were significantly more frequent in the poor recovery group (64.7% vs 34.3%, p=.012). Preoperative mJOA scores were lower (10.91±1.64 vs 14.31±1.51, p=.001), and grade 3 stenosis was more prevalent (82.4% vs 48.6%, p=.003) in poor recovery patients. MRS revealed elevated Cho/NAA (1.28±0.45 vs 0.94±0.26, p=0.001), Cr/NAA (1.26±0.52 vs 0.88±0.21, p=.001), and MIn/NAA (1.33±0.88 vs 0.89±0.37, p=.008) ratios in poor-recovery patients, all of which were inversely correlated with recovery rate. Logistic regression analysis identified 6 parameters as pred","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing patient-reported outcomes with objective surgical outcome measures using wearable technology in lumbar spine surgery: a systematic review and meta-analysis.","authors":"Natalie Slosar, Paul Carne, Nichloas Szerlip, Deb A Bhowmick, Noojan J Kazemi","doi":"10.1016/j.spinee.2026.07.004","DOIUrl":"10.1016/j.spinee.2026.07.004","url":null,"abstract":"<p><strong>Background context: </strong>Patient-reported outcome measures (PROMs) are considered the gold standard for assessing recovery following lumbar spine surgery, but they are subjective and may incompletely capture functional change. Wearable technologies, such as accelerometers and activity monitors, offer objective and continuous data. The extent to which wearable-derived (WD) metrics correlate with traditional PROMs remains uncertain.</p><p><strong>Purpose: </strong>To characterize the association between WD mobility metrics and PROMs following lumbar spine surgery and quantify domain-specific correlations.</p><p><strong>Study design: </strong>Systematic review and meta-analysis conducted according to PRISMA guidelines.</p><p><strong>Methods: </strong>A comprehensive search of PubMed/MEDLINE, Embase/Elsevier, and CINAHL was performed through August 2025, identifying 10,831 records. Eligible studies included patients undergoing lumbar surgery for degenerative conditions, reporting both PROMs and WD gait data, and providing correlation coefficients. For quantitative synthesis, studies reporting Pearson correlations of change in WD mobility metrics (eg, step count, gait velocity) with change in PROMs were included. One effect per study per domain (disability, pain, health-related quality of life) was extracted at the first postoperative time point ≥6 weeks. Correlations were Fisher z-transformed and pooled under random-effects models.</p><p><strong>Results: </strong>Fourteen studies met inclusion criteria, eight of which contributed to the meta-analysis. Pooled change-change correlations showed a strong association with disability (r=0.646, 95% CI 0.475-0.770), moderate association with pain (r=0.459, 95% CI 0.235-0.637), and weaker association with health-related quality-of-life (r=0.357, 95% CI 0.066-0.592). Gait velocity and composite indices had stronger correlations with PROM changes than daily step counts, which were less consistent.</p><p><strong>Conclusions: </strong>WD mobility metrics significantly correlate with PROM changes following lumbar spine surgery, particularly for disability. These findings support the integration of wearables as complementary tools for postoperative outcome assessment and demonstrate the need for standardization of metrics, timing, and reporting to facilitate clinical adoption.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definitions and diagnostic criteria of lumbar spine instability: a systematic review.","authors":"Nikita Gonugunta, Austin Kennemer, Aakash Shah, Michael P Steinmetz","doi":"10.1016/j.spinee.2026.06.002","DOIUrl":"10.1016/j.spinee.2026.06.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Lumbar spine instability is often cited as a contributor to chronic low back pain and radiculopathy, however there is no consensus definition or standardized diagnostic criteria across clinical practice. This lack of consolidated criteria complicates patient management and surgical planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To identify commonly used clinical, radiological, and patient-reported questionnaire criteria for defining lumbar instability and to highlight trends in the evolution of these definitions to guide clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Systematic review of published literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Studies evaluating adult patients for lumbar instability using clinical examination, radiographic imaging, or patient questionnaires.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Self-report Measures: Lumbar Spine Instability Questionnaire (LSIQ).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Physiologic measures: &lt;/strong&gt;Flexion-extension radiography, magnetic resonance imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Functional measures: &lt;/strong&gt;Reported symptom provocation with movement, activity-related functional limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of MEDLINE, Embase, CENTRAL, and Web of Science was conducted using MeSH terms and keywords including \"spine instability,\" \"radiographic instability,\" \"neurologic instability,\" and \"biomechanical instability.\" Eligible studies included adult patients evaluated for lumbar instability using at least one of the 3 domains: clinical examination, radiographic imaging, or patient-reported questionnaires. Studies were excluded if they involved pediatric populations, non-lumbar regions, instability of other joints, or non-clinical models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search yielded 1,043 records, of which 32 met inclusion criteria after screening. Clinical instability was most often described as a constellation of symptoms and signs (e.g., episodic pain triggered by movement, instability catch sign) rather than a single exam maneuver such as the lumbar rocking test. Radiographic definitions varied, though &gt;3 mm sagittal translation on flexion-extension radiographs were historically common. Recent literature emphasized multifactorial assessment, incorporating advanced imaging findings and contextual factors such as degenerative changes and patient positioning. Questionnaire-based definitions, particularly using the LSIQ, demonstrated reliability and captured the patient's subjective experience of instability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Lumbar instability is a multifactorial diagnosis that cannot be adequately defined by a single clinical test, radiographic threshold, or questionnaire alone. A standardized diagnostic framework incorporating at least two of the 3 domains of clinical signs, imaging findings, and patient-reported symptoms may optimize specificity and sensitivity and balance both biomechanical and patient-centere","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of lumbar total disc arthroplasty and hybrid constructs: a systematic review.","authors":"Samer G Salman, Rohan Phadke, Rahul Kumar, Karmen Gill, Swapna Vaja, Nathan J Lee, Christopher Bono","doi":"10.1016/j.spinee.2026.06.010","DOIUrl":"10.1016/j.spinee.2026.06.010","url":null,"abstract":"<p><strong>Background context: </strong>Lumbar total disc arthroplasty (TDA) was developed as a motion-preserving alternative to fusion for axial low back pain from disc degeneration with the theoretical goal of reducing the risk of adjacent segment disease (ASD). While short-term outcomes are well described, the durability of clinical benefit and the long-term impact on reoperation and ASD remain incompletely characterized, particularly for multilevel and hybrid constructs. No systematic review has specifically synthesized long-term outcomes across all configurations of lumbar motion-preserving surgery.</p><p><strong>Purpose: </strong>To systematically evaluate long-term (≥5-year) clinical outcomes, reoperation rates, and ASD following lumbar TDA, including single-level, multilevel, and hybrid (ie, fusion and TDA) constructs.</p><p><strong>Study design: </strong>Systematic review.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. PubMed (MEDLINE), Embase (via Ovid), and Cochrane CENTRAL were searched through December 31, 2025. The review was registered on PROSPERO. Eligible studies included prospective or retrospective cohort studies of adults with disc degeneration undergoing lumbar TDA (single-level, multilevel, or hybrid) with a minimum mean or median follow-up of 5 years and a sample size ≥30. Primary outcomes were ASD requiring surgical intervention, index-level revision or reoperation, and patient-reported outcomes. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies of interventions and RoB 2 for randomized controlled trials (RCTs). The results were synthesized narratively due to clinical heterogeneity.</p><p><strong>Results: </strong>Eighteen studies (4 RCTs, 14 observational), encompassing 3,346 patients, met the inclusion criteria, with follow-up ranging from 5.0 to 19.4 years across 8 device types and 10 countries. Lumbar TDA was associated with sustained improvements in pain and function. Index-level revision rates ranged from 0.67% to 19.9%. RCT evidence demonstrated TDA to be comparable or superior to fusion at 5-14 years. Surgically defined ASD was reported in 12 of 18 studies, with rates ranging from 0.8% to 5.1%; however, no study demonstrated a definitive reduction in surgically defined ASD attributable to TDA.</p><p><strong>Conclusions: </strong>Lumbar TDA provides durable long-term improvements in pain and function with low index-level revision rates, especially for single-level procedures. Across 18 studies, RCT evidence supports the durability of TDA outcomes, demonstrating comparable or superior results to fusion at 5-14 years. However, despite extended follow-up, current evidence does not substantiate a clear protective effect against ASD. High-quality, independently funded registry studies with standardized ASD definitions and long-term follow-up are needed to clarify the true benefits and limitations of lumbar TDA.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}